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Jesse C Staubach
Peer Specialist in Coos Bay, Oregon
NPI 1114560802

Jesse C Staubach is a Peer Specialist based in Coos Bay, OR. Jesse C Staubach practices in Coos Bay, OR. The NPI Number for Jesse C Staubach is 1114560802 and holds a License No. THW000003807 (Oregon).

The current practice location address for Jesse C Staubach is 320 Central Ave Ste 304, Coos Bay, OR and can be reached out via phone at 541-366-7640. You can also correspond with Jesse C Staubach through the mailing address at PO BOX 802, COOS BAY, OR - 97420-0148 (mailing address contact number: 541-295-9240).

Location: 320 Central Ave Ste 304, Coos Bay, OR, 97420-0148
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114560802
Provider Name
Jesse C Staubach
Credential
Provider Entity Type
Individual
Gender
Male
Address
320 Central Ave Ste 304, Coos Bay, OR, 97420-0148
Phone Number
541-366-7640
Fax Number
Provider Enumeration Date
10/24/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
320 Central Ave Ste 304
City
Coos Bay
State
Oregon
Zip
97420-2241
Phone Number
541-366-7640
Fax Number
person
Provider Business Mailing Address Details
Address
320 Central Ave Ste 304
City
Coos Bay
State
Oregon
Zip
97420-2241
Phone Number
541-366-7640
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
THW000003807 (Oregon)
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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